Individual
DR. MARK L DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5098 WEST WASHINGTON ST, STE 408, CROSS LANES, WV 25313-1419
(304) 776-5594
(304) 776-3521
Mailing address
5098 WEST WASHINGTON ST, STE 408, CROSS LANES, WV 25313-1419
(304) 776-5594
(304) 776-3521
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1390
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001722523
BLUE CROSS BLUE SHIELD
WV
01
—
0839644
MEDICARE PIN
WV
01
—
4333567
AETNA
WV
01
—
550773123
TAX ID
WV
Enumeration date
03/01/2007
Last updated
12/31/2012
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us